| ObjectiveCisatracurium is a new nondepolarizing neuromuscular blocking agent(NNBA) with an intermediate duration of action,cisatracurium does not trigger histamine release,blood dynamics stability,do not have accumulation effect etc,which undergoes Hofmann elimination(cleared by organ-independent mechanisms).Cisatracurium has been considered a wonderful drug but only has a relatively slow onset time,so this issue was performed to study two strategies,one was a small dose of ephedrine,the other was a small dose of cisatrucium,in order to shorten the onset time of muscle relacxation during general endotracheal anesthesia,provide the clinical observation with theory evidence for the safety.MethodsForty five ASA physical status 1 or 2 patients undergoing ear surgeries in the first hospital of China medical university under general anesthesia were include in the study. Aged 18 to 60 years,body mass index(BMI)19～24kg/m~2,exclusion criteria included any cardiovascular or neuromuscular disease as well as hepatic or rental impairment. Participating patients were randomly assigned to one of three groups:placebo group (group S),ephedrine group(group E),a small dose of cisatrucium group(group C),15 patients in each group,all were no preanesthetic medication.General endotracheal anaesthesia:Group S was induced with midazolam 0.03mg/kg,0.9%saline,sufentanile 0.5ug/kg,propofol 1.5mg/kg.Group E was induced with midazolam 0.03mg/kg, ephedrine 70ug/kg,sufentanile 0.5ug/kg,propofol 1.5mg/kg.Group C was induced with midazolam 0.03mg/kg,cisatracurium 0.015mg/kg,sufentanile 0.5ug/kg,propofol 1.5mg/kg,and all drugs were injected in 120s.The neuromuscular block was assessed at the adductor pollicis using accelography after loss of consciousness.Peripheral nerve stimulator of the pollicis adductor to atrain-of-four(TOF),stimulation pulse width at 200us,stimulation at 10s intervals with submaximal current 50ma.When twitch height(Th) stabilize at 100%,cisatracurium was administered.Group S and group E are both injected 0.15mg/kg cisatracurium,group C injected 0.135mg/kg cisatracurium,all drugs were injected in 5s.Tracheal intubation at 3 min after cisatracurium injection was performed within 15s,intubating conditions were rated by the intubator as excellent,good,poor or impossible.The times from the end of the cisatracurium bolus to 10%,25%,50%and maximum block were recorded.The heart rather(HR),mean arterial pressure(MAP) were recorded in every period of time during anesthesia administration,such as preanesthesia,after induction,before endotracheal intubation and 1,3,5 min after intubating.The value are reported as mean±SD,using analysis of variance for Unpaired Student's t-tests for measurement data.X~2-tests for categorical data.P＜0.05 was considered to be statistically significant.Results1.There were no statistically significant differences among the three groups in physical status ASA,sex,age,weight,height,BMI,haemoglobin(HB),red blood cell count(RBeL),et al(P＞0.05).2.There were no statistical differences in baseline HR and baseline MAP(P＞0.05).There were no statistical differences after indused and before endotracheal intubating.But only group E experienced marked tachycardia at 1min after tracheal intubation(p＜0.05).There were no statistical differences in HR and MAP at 3 and 5min after tracheal intubation(P＞0.05).3.There were statistical differences at each quantum onset time of the cisatracurium in each group(p＜0.01),the times to 10%neuromuscular blockade was shorter after ephedrine or a small dose of cisatracurium(64.3±17.1,66±17.4 vs91.7±23.8 ) s;the times to 25%neuromuscular blockade was(101.7±29.7, 108.9±34.0 vs 167.7±35.1) s;the times to 50%neuromuscular blockade was (138.2±36.8,143.5±33.8 vs 207.4±45.9) s;the times to 100%neuromuscular blockade was(172.0±41.2,178.9±42.7 vs 245.3±54.5) s.There were no statistical differences between group E and group C(P＞0.05).4.There was a significantly higher proportion of intubating conditions graded as 'excellent' in group E(86.7%) than in group S(53.3%)(p＜0.05).There was a significantly higher proportion of intubating conditions graded as 'excellent' in group C(73.3%) than in group S(53.3%)(p＜0.05).Conclusion1.We describe an onset time faster when cisatracurium was given during induction of anaesthesia after a small dose of ephedrine(70ug/kg).2.We describe an onset time faster when cisatracurium was given during induction of anaesthesia after a small dose of cisatracurium(0.015mg/kg).3.A low dose of ephedrine(70ug/kg) was given during induction of anaesthesia improves the intubating conditions while without significant adverse clinical effects. |
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